Theory-of-mind improvement in schizophrenia after integrative cognitive remediation: which patients benefit more?

Social cognition, and specifically theory of mind, is considered a key factor in predicting functional outcomes and quality of life in schizophrenia. Although cognitive remediation is an effective intervention for improving theory of mind, little is known about the factors that moderate this improvement. Therefore, the aim of this study is to identify moderators of theory-of-mind improvement in schizophrenia after integrative cognitive remediation (REHACOP). Data from two randomized controlled trials were used in this secondary analysis. The sample included 182 patients (experimental group = 94; active control group = 88) from the Mental Health Network in Álava (Spain). A comprehensive assessment of clinical symptoms, neurocognition, theory of mind, and functional outcome at baseline and follow-up was carried out. Hierarchical regression analyses were used to identify moderators of theory-of-mind improvement. Regardless of the patients' initial profiles, the REHACOP was effective in improving theory of mind (F = 27.00, p < .001). Regression analyses, however, revealed that baseline neurocognition (β = -0.223, t = -2.075, p = .039), baseline theory of mind (β = -0.325, t = -3.100, p = .002), and baseline positive symptoms (β = -0.243, t = -2.296, p = .023) played a moderating role in the improvement of theory of mind after the REHACOP. Results showed that those participants with lower baseline neurocognition and theory-of-mind scores and less positive symptoms obtained greater theory-of-mind benefits. Determining the factors that account for the different patterns of improvement after cognitive remediation could be helpful in the implementation of personalized cognitive remediation plans and for the appropriate use of healthcare resources.